gaps in these state-based data collection systems. The chapter concludes with recommendations calling for states to push for the collection of data on race, ethnicity, SEP, and acculturation and language use as much as possible, and for the Department of Health and Human Services (DHHS) to provide technical assistance, resources, and incentives to states to improve the collection and use of these data.

The panel commissioned a background paper on state-based data collection for its Workshop on Racial and Ethnic Data in Health (see the paper by Geppert et al., in Appendix E). This paper, which was presented at the workshop, drew on interviews with officials from four states about their racial and ethnic data collection as case studies on how states use such data and the problems they encounter in collecting and analyzing them. This chapter draws on the results presented in the paper.

In considering state-based data collection, it is important to note that states’ needs for social and demographic data on their populations are different from those of the federal government. State governments directly implement and evaluate health intervention programs in order to ensure the health of their populations. While the federal government also implements health programs and monitors public health, it does so, for the most part, in an indirect way through contracts that is more removed from actual implementation of the programs (the Indian Health Service is an exception).

The federal government must monitor the nation as a whole and cannot, because of resource constraints, regularly collect data on ethnic groups that do not represent a sizable portion of the national population. It therefore aggregates data on racial and ethnic groups into generally broad categories. States, on the other hand, must provide services for their own populations, which may include concentrated populations of particular ethnic groups; for example, Dominicans and Puerto Ricans in New York, Cubans in Florida, Hmong in Minnesota, and Mexicans in Texas.

These subgroups may have differing health and health care needs. For example, Puerto Ricans are more likely than other Hispanics to have low-birthweight babies (9.3 percent of live births compared with the 6.5 percent national average for all Hispanics) (National Center for Health Statistics, 2003); and Hawaiians have a lower rate of early prenatal care than other Asian and Pacific Islanders (79.1 percent, compared with 90.1 percent for mothers of Japanese descent, 87.0 percent for mothers of Chinese descent, 85.0 percent for mothers of Filipino descent, and 82.7 percent for mothers of other Asian or Pacific Islander descent) (National Center for Health Statistics, 2003).

For these reasons, the broad OMB categories may not be as appropriate for all states as they are for most federal-level data collection. States need data for specific ethnic subpopulations in order to target public health interventions and measure health outcomes and disparities, and these sub-

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